Thoracic surgeon and patient focus groups on decision-making in early-stage lung cancer surgery.

AIM: To investigate medical decision-making from the thoracic surgeons' and patients' perspectives in early-stage lung cancer. PATIENTS & METHODS: We conducted one focus group with thoracic surgeons (n = 15) and one with a group of early-stage lung cancer patients treated with surgery (n = 7). Focus groups were recorded, transcribed and coded for themes. RESULTS: For surgeons, surgical procedure choice was a primary concern, followed by the surgical treatment plan decision-making process. Survivors focused primarily on the physical and mental health-related postsurgical burden for which they felt they were not well prepared and placed less emphasis on surgical decision-making. CONCLUSION: As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.

Beliefs and attitudes towards participating in genetic research - a population based cross-sectional study.

BACKGROUND: Biobanks have the potential to offer a venue for chronic disease biomarker discovery, which would allow for disease early detection and for identification of carriers of a certain predictor biomarker. To assess the general attitudes towards genetic research and participation in biobanks in the Long Island/Queens area of New York, and what factors would predict a positive view of such research, participants from the NSLIJ hospital system were surveyed. METHODS: Participants were recruited at six hospital centers in the NSLIJ system during the summers of 2009 and again in 2011 (n = 1,041). Those who opted to participate were given a questionnaire containing 22 questions assessing demographics, lifestyle and attitudes towards genetic research. These questions addressed individual participant's beliefs about the importance of genetic research, willingness to participate in genetic research themselves, and their views on informed consent issues. RESULTS: Respondents took a generally positive view of genetic research in general, as well as their own participation in such research. Those with reservations were most likely to cite concerns over the privacy of their medical and genetic information. Those who were married tended to view genetic research as important, while those in the younger age group viewed it as less important. Prior blood donation of respondents was found to be a predictor of their approval for genetic research. Demographic factors were not found to be predictive of personal willingness to participate in genetic research, or of approval for the opt-out approach to consent. CONCLUSIONS: While respondents were generally inclined to approve of genetic research, and those who disapproved did not do so based on an underlying moral objection to such research, there is a disconnect between the belief in the importance of genetic research and the willingness of individuals to participate themselves. This indicates a continued concern for the ways in which genetic materials are safeguarded once they are collected. Also indicated was a general lack of understanding about the various consent processes that go along with genetic research, which should be addressed further to ensure the successful continuation of biobanks.

Vagus Nerve Stimulation and the Cardiovascular System.

The vagus nerve plays an important role in maintaining physiological homeostasis, which includes reflex pathways that regulate cardiac function. The link between vagus nerve activity and the high-frequency component of heart rate variability (HRV) has been well established, correlating with vagal tone. Recently, vagus nerve stimulation (VNS) has been investigated as a therapeutic for a multitude of diseases, such as treatment-resistant epilepsy, rheumatoid arthritis, Crohn's disease, and asthma. Because of the vagus nerve's innervation of the heart, VNS has been identified as a potential therapy for cardiovascular disorders, such as cardiac arrest, acute myocardial infarction, and stroke. Here, we review the current state of preclinical and clinical studies, as well as the potential application of VNS in relation to the cardiovascular system.

Examining posttraumatic growth and mental health difficulties in the aftermath of Hurricane Sandy.

OBJECTIVE: Hurricane Sandy continues to affect the mental health of New York residents. This study examined associations between Posttraumatic Growth (PTG) and mental health difficulties (MHD) including symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD). METHOD: Participants (N = 1,356) recruited from the New York metropolitan area completed questionnaires regarding their PTG, demographics, MHD, and hurricane experiences. A weighted least squares regression assessed the association between MHD and PTG. A post hoc analysis determined whether anxiety or depression moderated the effect of PTSD on PTG. RESULTS: All MHD were crudely associated with greater PTG. After adjustment, an increased PTSD score was significantly associated with a 0.20 unit increase in PTG (t = 6.05, p < .001); this did not hold for depression or anxiety symptoms. Higher PTG was associated with being non-White (B = 5.90, t = 6.49, p < .001), Hispanic (B = 3.38, t = 2.89, p = .004), a smoker (B = 3.18, t = 3.28, p = .001), and greater Hurricane Sandy exposure (t = 7.11, p < .001). The positive association between PTSD symptoms and PTG was weaker among participants with probable depression. CONCLUSION: Results suggest that participants with higher PTSD symptoms were more likely to grow from the impact of the storm, indicating resilience. Highly exposed participants were more likely to experience PTG. A decrease in PTG was found among those with both PTSD and depression symptoms. The development and implementation of interventions fostering PTG could be beneficial in clinical disaster response work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Preliminary Assessment of Hurricane Harvey Exposures and Mental Health Impact.

Hurricane Harvey made landfall in Houston, Texas on 25 August 2017, the psychological and physical effects of which are still unknown. We assessed hurricane exposure and the immediate mental health needs of the population to define public health priorities for a larger epidemiological study. Convenience sampling was used to recruit participants (n = 41) from the greater Houston area aged ≥18 years. Participants completed a questionnaire about demographics, hurricane exposures, and physical/mental health. Post-Traumatic Stress Disorder (PTSD) was measured with the Post-Traumatic Stress Disorder Checklist-S (PCL-S; a score ≥30 indicated probable PTSD symptoms). The Patient Health Questionnaire-4 (PHQ-4) was used to assess symptoms of depression and generalized anxiety disorder. The average PTSD score was 32.9 (SD = 17.1); a total of 46% of participants met the threshold for probable PTSD. Increased overall hurricane exposure (adjusted odds ratio (ORadj) 1.42; 95% confidence interval (CI): 1.06⁻2.05) and property-related exposure (ORadj 1.53; 95% CI: 1.07⁻2.18) were both statistically significantly associated with increased odds of probable PTSD symptoms. A perception of chemical/toxin exposure due to Hurricane Harvey was reported by 44% of participants. A higher number of personal or property exposures were associated with greater mental health symptoms three weeks post-hurricane. This work has implications for the ongoing response to Hurricane Harvey and for assessing the immediate needs of the population.

Displacement during Hurricane Sandy: The impact on mental health.

OBJECTIVE: To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area. DESIGN: Prospective, cross sectional. SETTING: NYC area residents, including Queens, Staten Island, and Long Island. PARTICIPANTS: In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use. MAIN OUTCOME MEASURES: Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use. RESULTS: Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted odds ratio [AOR]: 2.21, 95% CI: 1.73-2.82), depression (AOR: 1.37, 95% CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95% CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends/family versus at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95% CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95% CI: 0.30-0.92). CONCLUSIONS: Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.

The lasting mental health effects of Hurricane Sandy on residents of the Rockaways.

OBJECTIVE: To examine the impact of Hurricane Sandy on the mental health and substance use of residents of the Rockaways, which is a lower income, ethnically diverse region of NYC that was devastated by the hurricane. DESIGN: Prospective, cross sectional. SETTING: Rockaways, Queens, NYC community residents. PARTICIPANTS: From October 2013 to April 2015, 407 adult residents of the Rockaways completed self-report, validated measures of depression, anxiety, and post-traumatic stress symptoms as well as indicators of substance use (alcohol, illicit substance, and tobacco use) and exposure to Hurricane Sandy. MAIN OUTCOME MEASURES: Depression, anxiety, post-traumatic stress, alcohol use, illicit substance use, and tobacco use. RESULTS: Differences in exposure scores on outcomes were compared using Wilcoxon tests. Associations between hurricane exposure (categorized into "personal" and "property" exposure) and outcomes were investigated using logistic regression, adjusting for demographic covariates, mental health history, and time since hurricane. The study participants were predominately female (57.5 percent) and black (63.9 percent) and average age was 44.7 years. Multivariable results showed that property exposure scores were positively associated with increased risks of mental health difficulties across all three mental health symptom outcomes, but not substance use. Increased personal and total exposures were also significantly associated with increased Posttraumatic Stress Disorder symptoms. Substance use variables were not significantly associated with any of the hurricane exposure indicators. CONCLUSIONS: The present study quantifies the lasting impact that Hurricane Sandy has had on the mental health of Rockaways residents indicating the need for continued recovery efforts and increased mental health service provision in this vulnerable region.

Study Design and Results of a Population-Based Study on Perceived Stress Following Hurricane Sandy.

OBJECTIVE: Hurricane Sandy was one of the deadliest storms in US history, with at least 162 deaths and numerous injuries. This research aimed to quantify the impact of Hurricane Sandy on the New York metropolitan area. METHODS: The project included 601 volunteers aged at least 18 years who were recruited in Nassau, Suffolk, Queens, and Richmond counties and Staten Island between 2013 and 2014 through close partnerships with coalition community leaders. Participants completed a self-administered questionnaire on demographics and behavioral factors and a 35-point check off list on hurricane exposure. Perceived stress was assessed by using the 10-item Perceived Stress Scale (PSS). RESULTS: Participants had a mean stress score of 15.6 (SD=7.3; vs general population mean of 13.0), with 30.14% of the sample categorized as "high stress" (mean≥20). In the multivariable regression analysis, age was significantly negatively associated with PSS score. A reported history of mental health issues, Hispanic ethnicity, and overall exposure to Hurricane Sandy were statistically significantly associated with PSS score in a positive direction. CONCLUSIONS: Perceived stress was high in areas affected by Hurricane Sandy and was significantly associated with individual hurricane exposure. This study is a first step toward defining what segments of the population are more vulnerable and informing intervention and emergency preparedness efforts. (Disaster Med Public Health Preparedness. 2015;10:325-332).

Myelodysplastic syndromes spatial clusters in disease etiology and outcome.

The myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders. This study aims to advance the use of spatial modeling in disease etiology and monitoring based on reports on a large population (n = 984) of MDS patients diagnosed in the Eastern United States. The spatial MDS clustering was analyzed using SaTScan, and patient clinical characteristics were analyzed using logistic regression and Cox hazards models adjusting for covariates. One main and five secondary spatial clusters (p-value < 10-17-10-7) were identified. Patients living in high vs. low MDS incidence clusters tended to be older (ORadj = 1.04 [1.004, 1.07]) and smokers (ORadj = 2.9 [1.1, 7.4]). Mortality was associated with hemoglobin (HRadj = 0.7 [0.5, 0.9]), neutrophils (HRadj = 0.7 [0.6, 0.96]), platelets (HRadj = 0.5 [0.4, 0.7]), and blast (HRadj = 1.4 [1.1, 1.8]), but not clusters. The results suggest large geographic variations in MDS incidence rates. The biological aggressiveness of the disease is unlikely to be associated with its spatial distribution.

The impact of Hurricane Sandy on the mental health of New York area residents.

OBJECTIVE: To evaluate the long-term psychological impact of Hurricane Sandy on New York residents. DESIGN: Prospective, cross-sectional study. SETTING: Community-based study. PARTICIPANTS: From October 2013 to February 2015, 669 adults in Long Island, Queens, and Staten Island completed a survey on their behavioral and psychological health, demographics, and hurricane impact (ie, exposure). MAIN OUTCOME MEASURES: Depression, anxiety, and post-traumatic stress disorder (PTSD). RESULTS: Using multivariable logistic regression models, the relationships between Hurricane Sandy exposure and depression, anxiety, and PTSD were examined. Participants experienced an average of 3.9 exposures to Hurricane Sandy, most of which were related to property damage/loss. Probable depression was reported in 33.4 percent of participants, probable anxiety in 46 percent, and probable PTSD in 21.1 percent. Increased exposure to Hurricane Sandy was significantly associated with a greater likelihood of depression (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.04-1.14), anxiety (OR = 1.08, 95% CI: 1.03-1.13), and probable PTSD (OR = 1.32, 95% CI: 1.23-1.40), even after controlling for demographic factors known to increase susceptibility to mental health issues. CONCLUSIONS: Individuals affected by Hurricane Sandy reported high levels of mental health issues and were at an increased risk of depression, anxiety, and PTSD in the years following the storm. Recovery and prevention efforts should focus on mental health issues in affected populations.